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Query: UMLS:C0003090 (arthrodesis)
 8,374 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Juvenile ankylosing spondylitis (JAS) is a chronic inflammatory arthritis of the peripheral and axial skeleton, frequently accompanied by enthesitis. About four percent of patients with JAS have ulcerative colitis or Crohn's disease. Crohn's disease is the more common of the two and is diagnosed in 26 percent of patients with chronic spondyloarthropathy. In this paper, a 14-year-old male patient is presented as a typical case of juvenile ankylosing spondylitis and Crohn's disease with low back pain, morning stiffness, limited motion in anterior and lateral flexion and extension, left sacroiliitis, ankylosis in the apophyseal joints of the lumbar vertebrae, abdominal pain, bloody diarrhea, characteristic histopathologic changes of colonic involvement such as lymphoid follicles, fissures, submucosal polymorphonuclear cell infiltration and definite ganglion cells. The current therapy with mesalazin, having fewer side effects than sulfosalazin, and its applicability in combination with naproxen sodium is also discussed.
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PMID:A case of juvenile ankylosing spondylitis and Crohn's disease. 922 28

Thirty-three patients with low back pain underwent spinal fusion following a positively predicting external fixation test. Thirty-two spinal fusions and one sacroiliac joint fusion were performed. The complications following the use of the external fixator were significant. The results following spinal fusion were not related to the positive response to the external fixator. Multiple variables affect the results of spinal fusion. We feel that the external fixator test in low back pain management is very invasive, and its use cannot be justified.
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PMID:Temporary external fixation for low back pain: is it worth doing? 925 37

Studies attempting to correlate facet blocking with successful relief of pain after fusion have reached unfavorable results. These studies, however, did so in a retrospective fashion, and facet blocking was not the sole criterion by which surgical candidates were chosen. The current study is the first to use facet blocking in a prospective fashion and as the definitive criterion by which patients were chosen. Ninety-one patients with chronic low back pain who responded to bracing underwent 197 facet blocks. Twenty-eight patients who had > 70% relief of their pain for >6 h on three separate occasions were surgical candidates and underwent fusion along with two others with mechanical abnormalities but negative blocks. Pre- and postoperative Prolo (Prolo DJ, Oklund SA, Butcher M: Toward uniformity in evaluating results of lumbar spine operations. A paradigm applied to posterior lumbar interbody fusions. Spine 11:601-606, 1986) outcome scores were assigned and the patients underwent self-assessment. Twenty-three of 30 patients had successful fusion. Nineteen of 23 described 90% relief, 3 patients had 50-90% partial relief, and 1 failed by self-assessment. A preoperative mean Prolo score of 3.95 (range 2-7) improved to 7.7 (range 3-10) with fusion. Provocative facet blocking can be used to successfully predict outcome in patients undergoing arthrodesis for chronic low back pain.
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PMID:The value of provocative facet blocking as a predictor of success in lumbar spine fusion. 943 17

Interbody cage devices, used to assist interbody fusion, are rapidly gaining popularity in the surgical management of chronic low back pain. This update provides a structural classification of commonly used devices and assesses them against a set of clearly defined surgical goals, including ability to correct the existing mechanical deformation, ability to provide mechanical stability, ability to provide a suitable environment for arthrodesis, and ability to limit "built-in" morbidity. In addition, the materials used in the devices are examined regarding their biomechanical, biologic, and radiographic characteristics.
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PMID:Spine update lumbar interbody cages. 1172 49

The authors treated 16 patients with tuberculosis of the sacroiliac joint. Twelve were treated surgically and four were treated conservatively. The clinical symptoms were buttock and low back pain in all patients, and most had difficulty walking (68.6%) and had radicular pain in their lower limbs (50%). Of the 16 patients, four (15%) had associated tuberculous spondylitis, six (37.5%) had an abscess in the gluteal region, and two (12.5%) had an abscess in the inguinal region. The diagnosis was proven by pathologic specimen in 12 patients and by clinical symptoms, laboratory data, and radiologic findings in the remaining four patients. The authors classified tuberculous sacroiliitis into four types based on the clinical and radiologic findings. Types 1 and 2 were treated conservatively with chemotherapy alone, whereas Types 3 and 4 were treated with surgery and chemotherapy. Healing occurred and was evident in patients who had curettage and arthrodesis (Types 3 and 4) at a mean of 20.8 months, which was comparable with healing in the patients who had chemotherapy alone that occurred at a mean of 23.5 months (Types 1 and 2). The authors suggest that the new classification will be helpful in determining the therapeutic plan of tuberculous sacroiliitis.
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PMID:Sacroiliac joint tuberculosis. Classification and treatment. 997 94

Isthmic spondylolisthesis is a common condition and is frequently identified in the adult patient with low back pain. Although the natural history of this condition is not well defined, it is a common indication for nonoperative and operative treatment. The authors outline a systematic approach to the evaluation of the adult patient with isthmic spondylolisthesis. If radiologic studies are required, magnetic resonance imaging has improved the visualization of nerve-root compression in the neural foramen and is now widely used. Nonoperative treatment is the preferred approach in most symptomatic patients and is successful in as many as 60%. If nonoperative treatment fails, surgery may be recommended. Arthrodesis continues to be the mainstay of surgical treatment. Nerve-root decompression can be used in selected patients with radiculopathy. Although the Food and Drug Administration still considers the use of pedicle-screw instrumentation investigational or experimental, it has gained wide acceptance as an adjunct to fusion in the adult. It is important to note, however, that such use has not yet been proved safe and effective. Reduction of the spondylolisthetic segment has increased in acceptance for a small subset of patients with defined indications but carries a significant risk of complications.
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PMID:Isthmic Spondylolisthesis in the Adult. 1079 55

The most common procedure for surgical treatment of lumbar spondylolysis is intertransverse processes spinal arthrodesis with instrumentation. However, this procedure is associated with significant morbidity on long-term follow up. Direct repair of spondylolysis is an alternative method for preservation of motion segment and anatomic continuity in young adults with multiple level spondylolysis. From 1992 through 1998, six soldiers with a diagnosis of multiple level spondylolysis who complained of persistent low back pain were treated in our hospital. Spondylolysis involved two levels in five cases and three levels in one case. All patients underwent serial roentgenography of the lumbar spine and a staged pars interarticularis infiltration test with bupivacain 0.5%. Five patients underwent direct repair of the pars interarticularis defects with hook screws, translaminar screws, and bone graft, while one patient received conservative treatment. All surgically treated patients had either good or excellent results at a mean of 34.4 months follow-up. One patient who was treated nonsurgically still complained of sport restriction at 16 months follow-up. Direct repair of multiple pars interarticularis defects after a positive staged pars infiltration test can restore anatomic stability, relieve back pain, and preserve a greater range of motion of the lumbar spine in young patients with intact disc height.
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PMID:Management of multiple level spondylolysis of the lumbar spine in young males: a report of six cases. 1157 18

Since it first was introduced more than 90 years ago, disc arthrodesis remains the main surgical method for the treatment of degenerative disc disease. Although this procedure does relatively well in stabilizing the anterior column and relieving low back pain by eliminating motion, it is not physiologic and it alters the stress distribution on the adjacent segments. Although the issue of whether this stress alteration leads to symptomatic degeneration remains debatable, it probably is agreed that disc arthrodesis is not the best choice for correcting or preventing anterior column instability caused by degenerative disc disease. The ultimate solution for reestablishing anterior column stability is to restore not only the anatomy but also the normal mechanical function by using a more functional device, prosthetic disc replacement. During the past 401 years, many different designs have been attempted for prosthetic disc replacement. Many biomechanical studies have shown that normal mechanical functions of a disc can be restored by a disc prosthesis. Some early clinical studies have shown promising results. Although it might take more effort to optimize the design and reduce costs and risks, prosthetic disc replacement will be the future of spine care.
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PMID:Prosthetic disc replacement: the future? 1179 25

The value of preoperative provocative discography in the setting of discogenic low back pain was investigated by evaluating surgical outcomes. Seventy-three consecutive patients who underwent posterolateral interbody and posterior spinal arthrodesis for discogenic low back pain refractory to nonoperative management were reviewed. Chronologically, the first 41 patients (group A) were indicated without discography, whereas the remaining 32 (group B) had been indicated only if their pain had been reproduced during disc injection. The two groups were similar in demographic, psychometric, and radiologic parameters. Average follow-up time in group A was 2.8 years and in group B it was 2.4 years, both with a 2-year minimum. Using modified Oswestry scoring, group A and group B patients had satisfactory outcomes of 75.6% and 81.2%, respectively. This difference was neither statistically significant nor suggestive. In this study, provocative discography screening did not improve surgical outcomes after circumferential fusion for lumbar discogenic back pain.
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PMID:Does provocative discography screening of discogenic back pain improve surgical outcome? 1213 28

Nonspecific low back pain has long been a troublesome clinical entity in that the diagnoses are usually hard to define, and the effect of treatment unsure. We have been conducting long-term basic and clinical research in Zhujiang Hospital in an effort to find the exact mechanism for this disease and to explore its causal treatment. On the basis of literature review and treatment result evaluation, we recommend the following approaches for origin-specific diagnosis and treatments: (1) For spinal nerve dorsal ramus syndrome caused by mechanical stimulation on the stem part of the dorsal ramus, freezing the dorsal ramus with liquid-nitrogen may constitute the primary treatment. (2) In cases of low back pain originated from the lumbar disc due to degeneration of discs, treatment may be implemented through disc resection with or without arthrodesis. (3) Facet syndrome, a condition with low back pain that is seldom caused by pathological changes in the facet itself, but mostly by the pulling of the dorsal ramus due to the dislocation of the facet, should be attributed to the dorsal ramus syndrome. (4) Lumbar vertebra instability arising from loosened intervertebral conjunction calls for arthrodesis as the primary choice. (5) Interspinal ligaments injury can be most effectively treated by the combination of blocking and needle knife loosing. (6) Low back pain with underlying causes in the internal organs is often caused by diseases in the pelvic organs, and only these diseases are cured can the back pain be relieved. These origin-specific diagnosis and treatments we proposed here await further investigation and comments from our peers interested in this problem.
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PMID:[Cause-specific treatment for nonspecific low back pain]. 1248 May 73


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